Summaries for Patients|17 September 2013

Does Varenicline Help People With Depression Quit Smoking?
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The full report is titled “Effects of Varenicline on Smoking Cessation in Adults With Stably Treated Current or Past Major Depression. A Randomized Trial.” It is in the 17 September 2013 issue of Annals of Internal Medicine (volume 159, pages 390-400). The authors are R.M. Anthenelli, C. Morris, T.S. Ramey, S.J. Dubrava, K. Tsilkos, C. Russ, and C. Yunis.

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What is the problem and what is known about it so far?

About half of smokers seeking treatment for smoking cessation have a history of depression. Compared with smokers who are not depressed, those who are depressed have greater difficulty quitting, and relapse rates are high. Varenicline is a prescription medication used to treat smoking addiction. It acts by reducing nicotine withdrawal and blocking its rewarding effects. Studies have shown that varenicline boosts quit rates among smokers without depression, but little is known about its effect among smokers with depression.

Why did the researchers do this particular study?

To find out the effect of varenicline on smoking cessation and on mood and anxiety levels in smokers with depression.

Who was studied?

525 adults from 38 centers in 8 countries who smoked at least 10 cigarettes per day and were motivated to stop. All had stably treated current or past major depression and no recent cardiovascular events. Nearly three quarters were taking selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, benzodiazepines, or nonbenzodiazepine sedative hypnotics, but the researchers excluded participants taking medications prescribed for mania or psychosis.

How was the study done?

Participants took varenicline twice daily or placebo for 12 weeks. After treatment ended, researchers followed the participants for 40 weeks. During the study, they checked for any recent cigarette use (with a test that measures carbon monoxide in the breath) and measured ratings of mood, anxiety, and thoughts about suicide.

What did the researchers find?

Overall, 68% of the varenicline group and 67% of the placebo group completed the study. More participants in the varenicline group than in the placebo group quit smoking. During the last 4 weeks of treatment (weeks 9 to 12), 40% of those treated with varenicline had quit smoking compared with 16% in the placebo group. At the end of the 40-week follow-up, 20% of participants in the varenicline group continued to abstain from smoking compared with 10% in the placebo group. No differences were found between the groups in mood, anxiety, or thoughts about suicide, and depression did not worsen in either group. More patients in the varenicline group experienced nausea (27% vs. 10%).

What were the limitations of the study?

Some patients dropped out of the study, and these missing data could have affected the findings. Results may not apply to patients with untreated or active depression or co-occurring psychiatric conditions or to those taking mood stabilizers and antipsychotics.

What are the implications of the study?

Varenicline might help some patients with depression quit smoking, and it does not seem to worsen depression or anxiety.

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